NPI 1679634612

Provident Health Services, INC.

Organisation Clinical Genetics (M.D.) Physician Savannah, GA

Practice location

Address: 4700 Waters Ave, Savannah, GA 31404-6220
Phone: (912) 350-8490
Fax: (912) 350-8199
Mailing address: PO Box 933213, Atlanta, GA 31193-3213

Authorised official

Name: Robin J. Maddox
Title: Provider Enrollment Coordinator
Phone: (912) 350-9335

Registered specialties (2)

Clinical Genetics (M.D.) Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207SG0201X

Other Medical Genetics providers in Georgia →

Clinical Molecular Genetics Physician

Allopathic & Osteopathic Physicians Taxonomy 207SG0203X

Registry record

NPI: 1679634612
Entity type: Organization
NPI issued: 13 Dec 2006
Record last updated: 12 Nov 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.